No interoperability? Goodbye big data

You want genomic analysis and big data to take off? Don't count on it until interoperability becomes more than just a plan tossed about in federal HIT policy meetings. It actually needs to come to fruition, said Cleveland Clinic's Chief Information Officer C. Martin Harris. Otherwise, healthcare innovation: Welcome to limbo.

On a daily basis, the Cleveland Clinic has 300 basic core systems running, Harris pointed out at the 2014 Cleveland Clinic Innovation Summit last week. "I'm not talking about DNA sequencing machines or high-end big data computing," he said. "Just to open the doors every day, it's 300 systems that have to be coordinated left and right."

One of the myriad challenges hospitals face, he continued, is that patients are at the core: they decide which providers to see, and oftentimes, those clinicians aren't located at the same institution. "Interoperability is the way we can get that information where it needs to go in an effective fashion," Harris added. How else could you expect to take reams of fragmented data from disparate systems and transform it into meaningful information used to make clinical decisions? Short answer: you can't.

Indeed, interoperability proved itself a hot button topic throughout the innovation summit. Other stakeholders also echoed Harris' sentiments. Julie Vose, MD, professor at the University of Nebraska Medical Center and president-elect at the American Society of Clinical Oncology, was among them.

The "biggest bang for your buck" would be "healthcare IT that's interoperable between systems, being able to make sure that we have the data from patients that are from different institutions, different states," said Vose. That, she continued, is the "biggest issue actually in taking care of patients today."

ASCO is currently in the middle of rolling out CancerLinQ, a "very large" healthcare IT platform slated to launch in 2015 that puts together all of ASCO practices' data and provides analytics and realtime clinical decision support. By taking that big data, Vose said it "will help us understand treatments that are done every day."

"A lot of what is going to happen is utterly dependent on accuracy," added Harris. And that's not only where interoperability comes into play; it's also where patient engagement proves integral, as patients bring arguably the most valuable insight to their clinical records.

Harris remembered when Cleveland Clinic launched its online personal health record more than a decade ago, an initiative that received a great deal of coverage. He assumed the rollout was going to be hailed as a "gee-whiz" thing, but then his phone started to ring. "They were not pleasant calls," he recounted. "Why in the world would you ever think about putting a medical record online in any way, any shape, any form?"

It's going to be similar for big data, he said. But the clinical outcomes implications will be huge, particularly with engaged patients. "Patients will actually be the ones driving the adoption and also driving accuracy as we go forward. They have to be actively engaged in everything."

Cleveland Clinic is already ahead of many hospitals in this respect. Clinic patients are able to see the audit trail of anyone who accesses their clinical records from virtually anywhere across the enterprise. "It's twofold," he added. "They know the right people are doing it, but they also know that that activity is happening."